Pediatric Assessment & Selected Emergencies
DVD Post Test
V1-2008
Name____________________
Date____________________
MULTIPLE CHOICE. Choose the one alternative that best completes the statement or answers the
question.
1) Your patient is a 5-year-old boy with an allergic reaction to peanuts. He has hives, complains of nausea,
and is wheezing. You have already placed the patient on an albuterol treatment with supplemental oxygen.
Due to the speed with which the patient's signs and symptoms developed after exposure to the antigen, you
will be starting an intravenous line for medication administration and possible fluid infusion. Which of the
following is the best way to communicate with the patient regarding the IV? 1) _______
A) Just before placing the IV, tell him you must put a needle in his arm but that it is to give him medicine
that will make him feel better. Tell him it will hurt, but only for a second.
B) Be honest. Tell him it will hurt but that it's okay if he wants to cry. Let him know as far in advance as
possible so he has a chance to accept the idea.
C) Tell him you are going to "start an IV in his arm" but that it won't hurt a big boy like him.
D) Tell him nothing. Have a parent distract him while you quickly place the IV.
2) You are in the home of a 28-month-old male whose mother called EMS because he fell while running
and struck his forehead on the corner of a table. The patient has a hematoma on his forehead but seems to
have forgotten about the injury and is entertaining himself with some building blocks. Which of the
following is the best way to begin assessing the child? 2) _______
A) Sit next to him and ask if you can play with some of his toys.
B) Ask his mother to pick him up and hold him on her lap.
C) To avoid upsetting him, observe him from a distance and make no physical contact with him.
D) Pick him up from the floor with a cheerful, "Hey partner!"
3) Your patient is a 16-year-old female cheerleader who fell while attempting a pyramid formation and
struck her forehead on the back of another girl's head. She has a 2 cm laceration just above her right
eyebrow. She is tearful and asks you if you think she is going to have a scar. Which of the following is the
best response? 3) _______
A) "It's a small cut. They'll do everything they can at the emergency department to minimize scarring."
B) "You probably won't even notice it when you grow up."
C) "It's likely, but it's not something to get upset about."
D) "I really can't say. You should probably see a plastic surgeon as soon as possible."
4) Which of the following differences in the pediatric respiratory system should be considered when
assessing the pediatric patient?
1. You will most likely note that the child's abdomen rises and falls during respiration, more than that of an
adult.
2. Breath sounds from functional areas of the lung may be transmitted through the chest wall such that a
pneumothorax may go undetected.
3. The resiliency of the pediatric ribs causes them to absorb most of the energy from blunt trauma, thereby
protecting the underlying organs.
4. Although a child's smaller ribs fracture more easily, it is uncommon to see rib fractures in the abused
child.
5. The pediatric patient will more readily display mediastinal shift with a tension pneumothorax.
4) _______
A) 2, 3, and 4 B) 1, 2, 3, and 5
C) 1, 2, and 5 D) 1, 4, and 5
5) Which of the following is NOT part of the pediatric assessment triangle when forming your general
impression of the patient's condition? 5) _______
A) Blood glucose level
B) Circulation
C) Breathing
D) Appearance
6) Your patient is a 4-year-old male with a history of asthma. He ran out of his inhaled bronchodilator
while visiting his grandparent's farm. On your arrival, you learn that the patient has been having increasing
respiratory distress for 20 minutes. The patient has pale, cool, moist skin with cyanosis of his nail beds. He
is sitting on the edge of a kitchen chair, leaning forward to breathe. He has a respiratory rate of 50 with the
use of accessory muscles and a heart rate of 130. He is anxious and unable to speak more than one or two
words at a time. Auscultation of the chest reveals scattered wheezing. As you prepare to treat the patient, he
becomes drowsy and his respiratory rate decreases to 12. You can no longer auscultate his wheezes. Which
of the following best explains the significance of the change in your patient's status? 6) _______
A) This makes no sense in an asthma patient, and it is likely that the child ingested or was exposed to a
toxic substance, which explains the decreased level of consciousness.
B) Because of decreased respiratory, cardiovascular, and stored energy reserves, the child's muscles have
fatigued and he is now in respiratory failure.
C) The child has realized that you are going to treat him and is more relaxed than he was initially and has
stopped hyperventilating.
D) The absence of wheezing indicates that bronchospasm has resolved spontaneously and the child now
only needs supplemental oxygen.
7) When selecting an appropriately sized blood pressure cuff for a pediatric patient, which of the following
guidelines will help you select the right cuff for your patient? 7) _______
A) The width of the cuff should equal the circumference of the arm.
B) The width of the cuff should be 2/3 the circumference of the arm.
C) The width of the cuff should equal the length of the little finger.
D) The width of the cuff should equal the distance from the antecubital fossa to the axilla.
8) Which of the following is NOT a sign of respiratory distress in the pediatric patient? 8) _______
A) Grunting
B) Tachypnea
C) Bradycardia
D) A loud, high-pitched cry
9) Which of the following conditions does NOT cause of upper airway obstruction? 9) _______
A) Epiglottitis
B) Asthma
C) Croup
D) Bacterial tracheitis
10) Which of the following affects the lower airway? 10) ______
A) Laryngitis B) Pharyngitis C) Croup D) Pneumonia
11) Your patient is a 3-year-old child who has had a mild cold for 24 hours. This evening, the parents have
called EMS because the child awoke with a hoarse, "barking" cough and seems to be having some
difficulty breathing. You note that the child is afebrile and his breath sounds are clear but that he has
significant inspiratory stridor. His respiratory rate is 30, his pulse is 124, and he is anxious but lacks
peripheral cyanosis. Which of the following responses indicates the most likely cause and the appropriate
treatment of the child's problem? 11) ______
A) Epiglottitis, breathing cool night air
B) Asthma, albuterol
C) Bronchiolitis, racemic epinephrine
D) Laryngotracheobronchitis; humidified oxygen
12) Your patient is a 9-month-old infant in respiratory distress with grunting respirations of 50 per minute,
nasal flaring, and intercostal retractions. He is pale, and you note scattered bilateral wheezing on
auscultation of the lungs. The mother states that the child is healthy and up to date on all his
immunizations. Which of the following conditions is most likely, based on this information? 12) ______
A) Bronchiolitis due to respiratory syncytial virus
B) Bacterial tracheitis
C) New onset asthma
D) Epiglottitis due to Haemophilus Influenza B
13) Your patient is an 8-month-old infant who has a complete airway obstruction as a result of choking on
a slice of canned peach. Which of the following is your first intervention? 13) ______
A) A portable suction device, using a rigid tonsil tip and no more than 100 mmHg of vacuum
B) An alternating series of back blows and chest thrusts
C) Abdominal thrusts interspersed with attempts to ventilate
D) The use of a manually triggered flow-restricted oxygen-powered ventilation device
14) Your patient is a 14-month-old child who has been taking an antibiotic for 3 days for an ear infection.
Her parents have called EMS because the child has not been eating or drinking, is irritable, has a fever, and
generally appears very sick. Which of the following should you most highly suspect? 14) ______
A) Fifth disease
B) Herpes Zoster
C) Bacterial meningitis
D) An allergic reaction to the antibiotic
15) Your patient is a 24-month-old child whom you have determined to be hypoglycemic. Which of the
following is the best treatment for this patient? 15) ______
A) 25 ml of 25% dextrose
B) 25 ml of 50% dextrose
C) 10 ml of 25% dextrose
D) 10 ml of 50% dextrose
16) Toddlers are represented in which of the following age groups? 16) ______
A) 1 year to 2 years
B) 2 years to 4 years
C) 1 year to 3 years
D) 1 month to 2 years
17) You are caring for a 7-year-old girl who was run over by the neighborhood ice cream truck. Other than
some abrasions, the patient appears to have an isolated right femur fracture. The child is sobbing and
uncooperative, and her mother is nearly hysterical, pleading with you not to let her daughter die. Your
partner and the first responding engine crew are caring for the patient. Which of the following is the best
way to gain control of this situation? 17) ______
A) Tell the mother it is obvious from her daughter's screaming that she isn't in any immediate danger of
dying. Tell her to calm down or you may have to have the police remove her from the scene.
B) Tell the mother you can see how upset she is and that it would be better if she went inside the house
because watching her daughter's treatment is so upsetting to her.
C) Let the mother know that you and your partner are paramedics with special training in caring for injured
children. Tell her you will be stabilizing her daughter's leg to reduce her pain and that it would be very
helpful if she could get a favorite toy for her daughter to take to the hospital with her.
D) Let the mother know it is natural to feel guilty when her lack of supervision led to her daughter's injury.
Tell her that her daughter is probably not going to die but that it's hard to say right now if her leg is
permanently damaged.
18) At which of the following ages does the risk of foreign body airway obstruction become a significant
concern in the normally developing infant? 18) ______
A) 12 months B) 1 month C) 3 months D) 6 months
19) Your patient is a 15-year-old male who was kicked in the scrotum while playing with some friends. He
is complaining of excruciating pain in his testicles. Which of the following guidelines applies to the
examination of this patient? 19) ______
A) Make sure a paramedic of the same sex performs the exam.
B) Perform no examination of the genitals.
C) Make sure a paramedic of the opposite sex performs the exam.
D) Make sure his mother is present during the exam.
20) Which of the following anatomical differences dictate changes in airway management for the pediatric
patient?
1. The occiput is disproportionally large.
2. The face is small and has a flat nose.
3. The trachea is softer and more flexible.
4. The larynx is lower, at the level of the sternal notch. 20) ______
A) 1, 2, 3, and 4
B) 1 and 3
C) 1, 2, and 3
D) 1 and 2
21) Which of the following is a factor in the relatively high number of burn deaths in children? 21)
______
A) The have less subcutaneous fat, resulting in increased heat loss when the skin is damaged.
B) Their skin is thinner, requiring less exposure to heat to induce full-thickness burns.
C) Their high body surface area to volume ratio causes them to lose fluids more quickly when the skin is
damaged.
D) all of the above
22) Which of the following may compromise prehospital ventilation in the pediatric patient? 22) ______
A) Using 100 percent oxygen for more than 30 minutes
B) Cricoid pressure
C) Hyperextending the neck
D) Placing a folded towel under the shoulders
23) Your patient is a 5-year-old female who awoke with a harsh cough, sore throat, drooling, and high
fever. She has shallow respirations of 40 and inspiratory stridor. She is completely focused on breathing,
leaning forward on her outstretched arms. Which of the following is the best course of action? 23) ______
A) Provide high-flow oxygen by nonrebreathing mask, start an IV, and repeat a full set of vital signs every
5 minutes en route to the emergency department.
B) Provide blow-by oxygen, humidified if possible; transport without delay and avoid procedures that
might upset her.
C) Start an IV for administration of succinylcholine and midazolam for RSI, intubate the trachea, and
ventilate at a rate of 24 to 28 per minute.
D) Inspect the hypopharynx for edema and be prepared for immediate surgical cricothyrotomy if airway
obstruction is imminent.
24) Which of the following is true of asthma in the pediatric patient? 24) ______
A) Bronchodilators are primarily effective when treating the second phase of an asthma attack.
B) Bronchodilators are more effective in pediatric patients than in adults, and steroids are rarely indicated.
C) Oxygen and nebulized beta agonists are indicated in the initial phase of an asthma attack.
D) The primary therapeutic goal in the initial phase of an asthma attack is to rehydrate and administer
mucolytic and anti-inflammatory agents.
25) Your patient is a 9-year-old female who was injured when her hand slipped into a hole in the ground
while she was turning a cartwheel. She is upset and has an obvious deformity of her left humerus. She asks
you if her arm is broken. Which of the following is the best response? 25) ______
A) "I'm sure you'll be fine."
B) "I think it may be badly bruised."
C) "It looks that way, but an X-ray at the hospital will let us know for sure."
D) "I can't tell you what I think. I'm not a doctor."